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      Bringing the social and ethical responsibilities of computing to the forefront

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      There has been a remarkable surge in the use of algorithms and artificial intelligence to address a wide range of problems and challenges. While their adoption, particularly with the rise of AI, is reshaping nearly every industry sector, discipline, and area of research, such innovations often expose unexpected consequences that involve new norms, new expectations, and new rules and laws.

      To facilitate deeper understanding, the Social and Ethical Responsibilities of Computing (SERC), a cross-cutting initiative in the MIT Schwarzman College of Computing, recently brought together social scientists and humanists with computer scientists, engineers, and other computing faculty for an exploration of the ways in which the broad applicability of algorithms and AI has presented both opportunities and challenges in many aspects of society.

      “The very nature of our reality is changing. AI has the ability to do things that until recently were solely the realm of human intelligence — things that can challenge our understanding of what it means to be human,” remarked Daniel Huttenlocher, dean of the MIT Schwarzman College of Computing, in his opening address at the inaugural SERC Symposium. “This poses philosophical, conceptual, and practical questions on a scale not experienced since the start of the Enlightenment. In the face of such profound change, we need new conceptual maps for navigating the change.”

      The symposium offered a glimpse into the vision and activities of SERC in both research and education. “We believe our responsibility with SERC is to educate and equip our students and enable our faculty to contribute to responsible technology development and deployment,” said Georgia Perakis, the William F. Pounds Professor of Management in the MIT Sloan School of Management, co-associate dean of SERC, and the lead organizer of the symposium. “We’re drawing from the many strengths and diversity of disciplines across MIT and beyond and bringing them together to gain multiple viewpoints.”

      Through a succession of panels and sessions, the symposium delved into a variety of topics related to the societal and ethical dimensions of computing. In addition, 37 undergraduate and graduate students from a range of majors, including urban studies and planning, political science, mathematics, biology, electrical engineering and computer science, and brain and cognitive sciences, participated in a poster session to exhibit their research in this space, covering such topics as quantum ethics, AI collusion in storage markets, computing waste, and empowering users on social platforms for better content credibility.

      Showcasing a diversity of work

      In three sessions devoted to themes of beneficent and fair computing, equitable and personalized health, and algorithms and humans, the SERC Symposium showcased work by 12 faculty members across these domains.

      One such project from a multidisciplinary team of archaeologists, architects, digital artists, and computational social scientists aimed to preserve endangered heritage sites in Afghanistan with digital twins. The project team produced highly detailed interrogable 3D models of the heritage sites, in addition to extended reality and virtual reality experiences, as learning resources for audiences that cannot access these sites.

      In a project for the United Network for Organ Sharing, researchers showed how they used applied analytics to optimize various facets of an organ allocation system in the United States that is currently undergoing a major overhaul in order to make it more efficient, equitable, and inclusive for different racial, age, and gender groups, among others.

      Another talk discussed an area that has not yet received adequate public attention: the broader implications for equity that biased sensor data holds for the next generation of models in computing and health care.

      A talk on bias in algorithms considered both human bias and algorithmic bias, and the potential for improving results by taking into account differences in the nature of the two kinds of bias.

      Other highlighted research included the interaction between online platforms and human psychology; a study on whether decision-makers make systemic prediction mistakes on the available information; and an illustration of how advanced analytics and computation can be leveraged to inform supply chain management, operations, and regulatory work in the food and pharmaceutical industries.

      Improving the algorithms of tomorrow

      “Algorithms are, without question, impacting every aspect of our lives,” said Asu Ozdaglar, deputy dean of academics for the MIT Schwarzman College of Computing and head of the Department of Electrical Engineering and Computer Science, in kicking off a panel she moderated on the implications of data and algorithms.

      “Whether it’s in the context of social media, online commerce, automated tasks, and now a much wider range of creative interactions with the advent of generative AI tools and large language models, there’s little doubt that much more is to come,” Ozdaglar said. “While the promise is evident to all of us, there’s a lot to be concerned as well. This is very much time for imaginative thinking and careful deliberation to improve the algorithms of tomorrow.”

      Turning to the panel, Ozdaglar asked experts from computing, social science, and data science for insights on how to understand what is to come and shape it to enrich outcomes for the majority of humanity.

      Sarah Williams, associate professor of technology and urban planning at MIT, emphasized the critical importance of comprehending the process of how datasets are assembled, as data are the foundation for all models. She also stressed the need for research to address the potential implication of biases in algorithms that often find their way in through their creators and the data used in their development. “It’s up to us to think about our own ethical solutions to these problems,” she said. “Just as it’s important to progress with the technology, we need to start the field of looking at these questions of what biases are in the algorithms? What biases are in the data, or in that data’s journey?”

      Shifting focus to generative models and whether the development and use of these technologies should be regulated, the panelists — which also included MIT’s Srini Devadas, professor of electrical engineering and computer science, John Horton, professor of information technology, and Simon Johnson, professor of entrepreneurship — all concurred that regulating open-source algorithms, which are publicly accessible, would be difficult given that regulators are still catching up and struggling to even set guardrails for technology that is now 20 years old.

      Returning to the question of how to effectively regulate the use of these technologies, Johnson proposed a progressive corporate tax system as a potential solution. He recommends basing companies’ tax payments on their profits, especially for large corporations whose massive earnings go largely untaxed due to offshore banking. By doing so, Johnson said that this approach can serve as a regulatory mechanism that discourages companies from trying to “own the entire world” by imposing disincentives.

      The role of ethics in computing education

      As computing continues to advance with no signs of slowing down, it is critical to educate students to be intentional in the social impact of the technologies they will be developing and deploying into the world. But can one actually be taught such things? If so, how?

      Caspar Hare, professor of philosophy at MIT and co-associate dean of SERC, posed this looming question to faculty on a panel he moderated on the role of ethics in computing education. All experienced in teaching ethics and thinking about the social implications of computing, each panelist shared their perspective and approach.

      A strong advocate for the importance of learning from history, Eden Medina, associate professor of science, technology, and society at MIT, said that “often the way we frame computing is that everything is new. One of the things that I do in my teaching is look at how people have confronted these issues in the past and try to draw from them as a way to think about possible ways forward.” Medina regularly uses case studies in her classes and referred to a paper written by Yale University science historian Joanna Radin on the Pima Indian Diabetes Dataset that raised ethical issues on the history of that particular collection of data that many don’t consider as an example of how decisions around technology and data can grow out of very specific contexts.

      Milo Phillips-Brown, associate professor of philosophy at Oxford University, talked about the Ethical Computing Protocol that he co-created while he was a SERC postdoc at MIT. The protocol, a four-step approach to building technology responsibly, is designed to train computer science students to think in a better and more accurate way about the social implications of technology by breaking the process down into more manageable steps. “The basic approach that we take very much draws on the fields of value-sensitive design, responsible research and innovation, participatory design as guiding insights, and then is also fundamentally interdisciplinary,” he said.

      Fields such as biomedicine and law have an ethics ecosystem that distributes the function of ethical reasoning in these areas. Oversight and regulation are provided to guide front-line stakeholders and decision-makers when issues arise, as are training programs and access to interdisciplinary expertise that they can draw from. “In this space, we have none of that,” said John Basl, associate professor of philosophy at Northeastern University. “For current generations of computer scientists and other decision-makers, we’re actually making them do the ethical reasoning on their own.” Basl commented further that teaching core ethical reasoning skills across the curriculum, not just in philosophy classes, is essential, and that the goal shouldn’t be for every computer scientist be a professional ethicist, but for them to know enough of the landscape to be able to ask the right questions and seek out the relevant expertise and resources that exists.

      After the final session, interdisciplinary groups of faculty, students, and researchers engaged in animated discussions related to the issues covered throughout the day during a reception that marked the conclusion of the symposium. More

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      Joining the battle against health care bias

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      Medical researchers are awash in a tsunami of clinical data. But we need major changes in how we gather, share, and apply this data to bring its benefits to all, says Leo Anthony Celi, principal research scientist at the MIT Laboratory for Computational Physiology (LCP). 

      One key change is to make clinical data of all kinds openly available, with the proper privacy safeguards, says Celi, a practicing intensive care unit (ICU) physician at the Beth Israel Deaconess Medical Center (BIDMC) in Boston. Another key is to fully exploit these open data with multidisciplinary collaborations among clinicians, academic investigators, and industry. A third key is to focus on the varying needs of populations across every country, and to empower the experts there to drive advances in treatment, says Celi, who is also an associate professor at Harvard Medical School. 

      In all of this work, researchers must actively seek to overcome the perennial problem of bias in understanding and applying medical knowledge. This deeply damaging problem is only heightened with the massive onslaught of machine learning and other artificial intelligence technologies. “Computers will pick up all our unconscious, implicit biases when we make decisions,” Celi warns.

      Play video

      Sharing medical data 

      Founded by the LCP, the MIT Critical Data consortium builds communities across disciplines to leverage the data that are routinely collected in the process of ICU care to understand health and disease better. “We connect people and align incentives,” Celi says. “In order to advance, hospitals need to work with universities, who need to work with industry partners, who need access to clinicians and data.” 

      The consortium’s flagship project is the MIMIC (medical information marked for intensive care) ICU database built at BIDMC. With about 35,000 users around the world, the MIMIC cohort is the most widely analyzed in critical care medicine. 

      International collaborations such as MIMIC highlight one of the biggest obstacles in health care: most clinical research is performed in rich countries, typically with most clinical trial participants being white males. “The findings of these trials are translated into treatment recommendations for every patient around the world,” says Celi. “We think that this is a major contributor to the sub-optimal outcomes that we see in the treatment of all sorts of diseases in Africa, in Asia, in Latin America.” 

      To fix this problem, “groups who are disproportionately burdened by disease should be setting the research agenda,” Celi says. 

      That’s the rule in the “datathons” (health hackathons) that MIT Critical Data has organized in more than two dozen countries, which apply the latest data science techniques to real-world health data. At the datathons, MIT students and faculty both learn from local experts and share their own skill sets. Many of these several-day events are sponsored by the MIT Industrial Liaison Program, the MIT International Science and Technology Initiatives program, or the MIT Sloan Latin America Office. 

      Datathons are typically held in that country’s national language or dialect, rather than English, with representation from academia, industry, government, and other stakeholders. Doctors, nurses, pharmacists, and social workers join up with computer science, engineering, and humanities students to brainstorm and analyze potential solutions. “They need each other’s expertise to fully leverage and discover and validate the knowledge that is encrypted in the data, and that will be translated into the way they deliver care,” says Celi. 

      “Everywhere we go, there is incredible talent that is completely capable of designing solutions to their health-care problems,” he emphasizes. The datathons aim to further empower the professionals and students in the host countries to drive medical research, innovation, and entrepreneurship.

      Play video

      Fighting built-in bias 

      Applying machine learning and other advanced data science techniques to medical data reveals that “bias exists in the data in unimaginable ways” in every type of health product, Celi says. Often this bias is rooted in the clinical trials required to approve medical devices and therapies. 

      One dramatic example comes from pulse oximeters, which provide readouts on oxygen levels in a patient’s blood. It turns out that these devices overestimate oxygen levels for people of color. “We have been under-treating individuals of color because the nurses and the doctors have been falsely assured that their patients have adequate oxygenation,” he says. “We think that we have harmed, if not killed, a lot of individuals in the past, especially during Covid, as a result of a technology that was not designed with inclusive test subjects.” 

      Such dangers only increase as the universe of medical data expands. “The data that we have available now for research is maybe two or three levels of magnitude more than what we had even 10 years ago,” Celi says. MIMIC, for example, now includes terabytes of X-ray, echocardiogram, and electrocardiogram data, all linked with related health records. Such enormous sets of data allow investigators to detect health patterns that were previously invisible. 

      “But there is a caveat,” Celi says. “It is trivial for computers to learn sensitive attributes that are not very obvious to human experts.” In a study released last year, for instance, he and his colleagues showed that algorithms can tell if a chest X-ray image belongs to a white patient or person of color, even without looking at any other clinical data. 

      “More concerningly, groups including ours have demonstrated that computers can learn easily if you’re rich or poor, just from your imaging alone,” Celi says. “We were able to train a computer to predict if you are on Medicaid, or if you have private insurance, if you feed them with chest X-rays without any abnormality. So again, computers are catching features that are not visible to the human eye.” And these features may lead algorithms to advise against therapies for people who are Black or poor, he says. 

      Opening up industry opportunities 

      Every stakeholder stands to benefit when pharmaceutical firms and other health-care corporations better understand societal needs and can target their treatments appropriately, Celi says. 

      “We need to bring to the table the vendors of electronic health records and the medical device manufacturers, as well as the pharmaceutical companies,” he explains. “They need to be more aware of the disparities in the way that they perform their research. They need to have more investigators representing underrepresented groups of people, to provide that lens to come up with better designs of health products.” 

      Corporations could benefit by sharing results from their clinical trials, and could immediately see these potential benefits by participating in datathons, Celi says. “They could really witness the magic that happens when that data is curated and analyzed by students and clinicians with different backgrounds from different countries. So we’re calling out our partners in the pharmaceutical industry to organize these events with us!”  More

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      Researchers develop novel AI-based estimator for manufacturing medicine

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      When medical companies manufacture the pills and tablets that treat any number of illnesses, aches, and pains, they need to isolate the active pharmaceutical ingredient from a suspension and dry it. The process requires a human operator to monitor an industrial dryer, agitate the material, and watch for the compound to take on the right qualities for compressing into medicine. The job depends heavily on the operator’s observations.   

      Methods for making that process less subjective and a lot more efficient are the subject of a recent Nature Communications paper authored by researchers at MIT and Takeda. The paper’s authors devise a way to use physics and machine learning to categorize the rough surfaces that characterize particles in a mixture. The technique, which uses a physics-enhanced autocorrelation-based estimator (PEACE), could change pharmaceutical manufacturing processes for pills and powders, increasing efficiency and accuracy and resulting in fewer failed batches of pharmaceutical products.  

      “Failed batches or failed steps in the pharmaceutical process are very serious,” says Allan Myerson, a professor of practice in the MIT Department of Chemical Engineering and one of the study’s authors. “Anything that improves the reliability of the pharmaceutical manufacturing, reduces time, and improves compliance is a big deal.”

      The team’s work is part of an ongoing collaboration between Takeda and MIT, launched in 2020. The MIT-Takeda Program aims to leverage the experience of both MIT and Takeda to solve problems at the intersection of medicine, artificial intelligence, and health care.

      In pharmaceutical manufacturing, determining whether a compound is adequately mixed and dried ordinarily requires stopping an industrial-sized dryer and taking samples off the manufacturing line for testing. Researchers at Takeda thought artificial intelligence could improve the task and reduce stoppages that slow down production. Originally the research team planned to use videos to train a computer model to replace a human operator. But determining which videos to use to train the model still proved too subjective. Instead, the MIT-Takeda team decided to illuminate particles with a laser during filtration and drying, and measure particle size distribution using physics and machine learning. 

      “We just shine a laser beam on top of this drying surface and observe,” says Qihang Zhang, a doctoral student in MIT’s Department of Electrical Engineering and Computer Science and the study’s first author. 

      Play video

      A physics-derived equation describes the interaction between the laser and the mixture, while machine learning characterizes the particle sizes. The process doesn’t require stopping and starting the process, which means the entire job is more secure and more efficient than standard operating procedure, according to George Barbastathis, professor of mechanical engineering at MIT and corresponding author of the study.

      The machine learning algorithm also does not require many datasets to learn its job, because the physics allows for speedy training of the neural network.

      “We utilize the physics to compensate for the lack of training data, so that we can train the neural network in an efficient way,” says Zhang. “Only a tiny amount of experimental data is enough to get a good result.”

      Today, the only inline processes used for particle measurements in the pharmaceutical industry are for slurry products, where crystals float in a liquid. There is no method for measuring particles within a powder during mixing. Powders can be made from slurries, but when a liquid is filtered and dried its composition changes, requiring new measurements. In addition to making the process quicker and more efficient, using the PEACE mechanism makes the job safer because it requires less handling of potentially highly potent materials, the authors say. 

      The ramifications for pharmaceutical manufacturing could be significant, allowing drug production to be more efficient, sustainable, and cost-effective, by reducing the number of experiments companies need to conduct when making products. Monitoring the characteristics of a drying mixture is an issue the industry has long struggled with, according to Charles Papageorgiou, the director of Takeda’s Process Chemistry Development group and one of the study’s authors. 

      “It is a problem that a lot of people are trying to solve, and there isn’t a good sensor out there,” says Papageorgiou. “This is a pretty big step change, I think, with respect to being able to monitor, in real time, particle size distribution.”

      Papageorgiou said that the mechanism could have applications in other industrial pharmaceutical operations. At some point, the laser technology may be able to train video imaging, allowing manufacturers to use a camera for analysis rather than laser measurements. The company is now working to assess the tool on different compounds in its lab. 

      The results come directly from collaboration between Takeda and three MIT departments: Mechanical Engineering, Chemical Engineering, and Electrical Engineering and Computer Science. Over the last three years, researchers at MIT and Takeda have worked together on 19 projects focused on applying machine learning and artificial intelligence to problems in the health-care and medical industry as part of the MIT-Takeda Program. 

      Often, it can take years for academic research to translate to industrial processes. But researchers are hopeful that direct collaboration could shorten that timeline. Takeda is a walking distance away from MIT’s campus, which allowed researchers to set up tests in the company’s lab, and real-time feedback from Takeda helped MIT researchers structure their research based on the company’s equipment and operations. 

      Combining the expertise and mission of both entities helps researchers ensure their experimental results will have real-world implications. The team has already filed for two patents and has plans to file for a third.   More

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      Helping companies deploy AI models more responsibly

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      Companies today are incorporating artificial intelligence into every corner of their business. The trend is expected to continue until machine-learning models are incorporated into most of the products and services we interact with every day.

      As those models become a bigger part of our lives, ensuring their integrity becomes more important. That’s the mission of Verta, a startup that spun out of MIT’s Computer Science and Artificial Intelligence Laboratory (CSAIL).

      Verta’s platform helps companies deploy, monitor, and manage machine-learning models safely and at scale. Data scientists and engineers can use Verta’s tools to track different versions of models, audit them for bias, test them before deployment, and monitor their performance in the real world.

      “Everything we do is to enable more products to be built with AI, and to do that safely,” Verta founder and CEO Manasi Vartak SM ’14, PhD ’18 says. “We’re already seeing with ChatGPT how AI can be used to generate data, artefacts — you name it — that look correct but aren’t correct. There needs to be more governance and control in how AI is being used, particularly for enterprises providing AI solutions.”

      Verta is currently working with large companies in health care, finance, and insurance to help them understand and audit their models’ recommendations and predictions. It’s also working with a number of high-growth tech companies looking to speed up deployment of new, AI-enabled solutions while ensuring those solutions are used appropriately.

      Vartak says the company has been able to decrease the time it takes customers to deploy AI models by orders of magnitude while ensuring those models are explainable and fair — an especially important factor for companies in highly regulated industries.

      Health care companies, for example, can use Verta to improve AI-powered patient monitoring and treatment recommendations. Such systems need to be thoroughly vetted for errors and biases before they’re used on patients.

      “Whether it’s bias or fairness or explainability, it goes back to our philosophy on model governance and management,” Vartak says. “We think of it like a preflight checklist: Before an airplane takes off, there’s a set of checks you need to do before you get your airplane off the ground. It’s similar with AI models. You need to make sure you’ve done your bias checks, you need to make sure there’s some level of explainability, you need to make sure your model is reproducible. We help with all of that.”

      From project to product

      Before coming to MIT, Vartak worked as a data scientist for a social media company. In one project, after spending weeks tuning machine-learning models that curated content to show in people’s feeds, she learned an ex-employee had already done the same thing. Unfortunately, there was no record of what they did or how it affected the models.

      For her PhD at MIT, Vartak decided to build tools to help data scientists develop, test, and iterate on machine-learning models. Working in CSAIL’s Database Group, Vartak recruited a team of graduate students and participants in MIT’s Undergraduate Research Opportunities Program (UROP).

      “Verta would not exist without my work at MIT and MIT’s ecosystem,” Vartak says. “MIT brings together people on the cutting edge of tech and helps us build the next generation of tools.”

      The team worked with data scientists in the CSAIL Alliances program to decide what features to build and iterated based on feedback from those early adopters. Vartak says the resulting project, named ModelDB, was the first open-source model management system.

      Vartak also took several business classes at the MIT Sloan School of Management during her PhD and worked with classmates on startups that recommended clothing and tracked health, spending countless hours in the Martin Trust Center for MIT Entrepreneurship and participating in the center’s delta v summer accelerator.

      “What MIT lets you do is take risks and fail in a safe environment,” Vartak says. “MIT afforded me those forays into entrepreneurship and showed me how to go about building products and finding first customers, so by the time Verta came around I had done it on a smaller scale.”

      ModelDB helped data scientists train and track models, but Vartak quickly saw the stakes were higher once models were deployed at scale. At that point, trying to improve (or accidentally breaking) models can have major implications for companies and society. That insight led Vartak to begin building Verta.

      “At Verta, we help manage models, help run models, and make sure they’re working as expected, which we call model monitoring,” Vartak explains. “All of those pieces have their roots back to MIT and my thesis work. Verta really evolved from my PhD project at MIT.”

      Verta’s platform helps companies deploy models more quickly, ensure they continue working as intended over time, and manage the models for compliance and governance. Data scientists can use Verta to track different versions of models and understand how they were built, answering questions like how data were used and which explainability or bias checks were run. They can also vet them by running them through deployment checklists and security scans.

      “Verta’s platform takes the data science model and adds half a dozen layers to it to transform it into something you can use to power, say, an entire recommendation system on your website,” Vartak says. “That includes performance optimizations, scaling, and cycle time, which is how quickly you can take a model and turn it into a valuable product, as well as governance.”

      Supporting the AI wave

      Vartak says large companies often use thousands of different models that influence nearly every part of their operations.

      “An insurance company, for example, will use models for everything from underwriting to claims, back-office processing, marketing, and sales,” Vartak says. “So, the diversity of models is really high, there’s a large volume of them, and the level of scrutiny and compliance companies need around these models are very high. They need to know things like: Did you use the data you were supposed to use? Who were the people who vetted it? Did you run explainability checks? Did you run bias checks?”

      Vartak says companies that don’t adopt AI will be left behind. The companies that ride AI to success, meanwhile, will need well-defined processes in place to manage their ever-growing list of models.

      “In the next 10 years, every device we interact with is going to have intelligence built in, whether it’s a toaster or your email programs, and it’s going to make your life much, much easier,” Vartak says. “What’s going to enable that intelligence are better models and software, like Verta, that help you integrate AI into all of these applications very quickly.” More

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      Subtle biases in AI can influence emergency decisions

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      It’s no secret that people harbor biases — some unconscious, perhaps, and others painfully overt. The average person might suppose that computers — machines typically made of plastic, steel, glass, silicon, and various metals — are free of prejudice. While that assumption may hold for computer hardware, the same is not always true for computer software, which is programmed by fallible humans and can be fed data that is, itself, compromised in certain respects.

      Artificial intelligence (AI) systems — those based on machine learning, in particular — are seeing increased use in medicine for diagnosing specific diseases, for example, or evaluating X-rays. These systems are also being relied on to support decision-making in other areas of health care. Recent research has shown, however, that machine learning models can encode biases against minority subgroups, and the recommendations they make may consequently reflect those same biases.

      A new study by researchers from MIT’s Computer Science and Artificial Intelligence Laboratory (CSAIL) and the MIT Jameel Clinic, which was published last month in Communications Medicine, assesses the impact that discriminatory AI models can have, especially for systems that are intended to provide advice in urgent situations. “We found that the manner in which the advice is framed can have significant repercussions,” explains the paper’s lead author, Hammaad Adam, a PhD student at MIT’s Institute for Data Systems and Society. “Fortunately, the harm caused by biased models can be limited (though not necessarily eliminated) when the advice is presented in a different way.” The other co-authors of the paper are Aparna Balagopalan and Emily Alsentzer, both PhD students, and the professors Fotini Christia and Marzyeh Ghassemi.

      AI models used in medicine can suffer from inaccuracies and inconsistencies, in part because the data used to train the models are often not representative of real-world settings. Different kinds of X-ray machines, for instance, can record things differently and hence yield different results. Models trained predominately on white people, moreover, may not be as accurate when applied to other groups. The Communications Medicine paper is not focused on issues of that sort but instead addresses problems that stem from biases and on ways to mitigate the adverse consequences.

      A group of 954 people (438 clinicians and 516 nonexperts) took part in an experiment to see how AI biases can affect decision-making. The participants were presented with call summaries from a fictitious crisis hotline, each involving a male individual undergoing a mental health emergency. The summaries contained information as to whether the individual was Caucasian or African American and would also mention his religion if he happened to be Muslim. A typical call summary might describe a circumstance in which an African American man was found at home in a delirious state, indicating that “he has not consumed any drugs or alcohol, as he is a practicing Muslim.” Study participants were instructed to call the police if they thought the patient was likely to turn violent; otherwise, they were encouraged to seek medical help.

      The participants were randomly divided into a control or “baseline” group plus four other groups designed to test responses under slightly different conditions. “We want to understand how biased models can influence decisions, but we first need to understand how human biases can affect the decision-making process,” Adam notes. What they found in their analysis of the baseline group was rather surprising: “In the setting we considered, human participants did not exhibit any biases. That doesn’t mean that humans are not biased, but the way we conveyed information about a person’s race and religion, evidently, was not strong enough to elicit their biases.”

      The other four groups in the experiment were given advice that either came from a biased or unbiased model, and that advice was presented in either a “prescriptive” or a “descriptive” form. A biased model would be more likely to recommend police help in a situation involving an African American or Muslim person than would an unbiased model. Participants in the study, however, did not know which kind of model their advice came from, or even that models delivering the advice could be biased at all. Prescriptive advice spells out what a participant should do in unambiguous terms, telling them they should call the police in one instance or seek medical help in another. Descriptive advice is less direct: A flag is displayed to show that the AI system perceives a risk of violence associated with a particular call; no flag is shown if the threat of violence is deemed small.  

      A key takeaway of the experiment is that participants “were highly influenced by prescriptive recommendations from a biased AI system,” the authors wrote. But they also found that “using descriptive rather than prescriptive recommendations allowed participants to retain their original, unbiased decision-making.” In other words, the bias incorporated within an AI model can be diminished by appropriately framing the advice that’s rendered. Why the different outcomes, depending on how advice is posed? When someone is told to do something, like call the police, that leaves little room for doubt, Adam explains. However, when the situation is merely described — classified with or without the presence of a flag — “that leaves room for a participant’s own interpretation; it allows them to be more flexible and consider the situation for themselves.”

      Second, the researchers found that the language models that are typically used to offer advice are easy to bias. Language models represent a class of machine learning systems that are trained on text, such as the entire contents of Wikipedia and other web material. When these models are “fine-tuned” by relying on a much smaller subset of data for training purposes — just 2,000 sentences, as opposed to 8 million web pages — the resultant models can be readily biased.  

      Third, the MIT team discovered that decision-makers who are themselves unbiased can still be misled by the recommendations provided by biased models. Medical training (or the lack thereof) did not change responses in a discernible way. “Clinicians were influenced by biased models as much as non-experts were,” the authors stated.

      “These findings could be applicable to other settings,” Adam says, and are not necessarily restricted to health care situations. When it comes to deciding which people should receive a job interview, a biased model could be more likely to turn down Black applicants. The results could be different, however, if instead of explicitly (and prescriptively) telling an employer to “reject this applicant,” a descriptive flag is attached to the file to indicate the applicant’s “possible lack of experience.”

      The implications of this work are broader than just figuring out how to deal with individuals in the midst of mental health crises, Adam maintains.  “Our ultimate goal is to make sure that machine learning models are used in a fair, safe, and robust way.” More

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      Large language models help decipher clinical notes

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      Electronic health records (EHRs) need a new public relations manager. Ten years ago, the U.S. government passed a law that required hospitals to digitize their health records with the intent of improving and streamlining care. The enormous amount of information in these now-digital records could be used to answer very specific questions beyond the scope of clinical trials: What’s the right dose of this medication for patients with this height and weight? What about patients with a specific genomic profile?

      Unfortunately, most of the data that could answer these questions is trapped in doctor’s notes, full of jargon and abbreviations. These notes are hard for computers to understand using current techniques — extracting information requires training multiple machine learning models. Models trained for one hospital, also, don’t work well at others, and training each model requires domain experts to label lots of data, a time-consuming and expensive process. 

      An ideal system would use a single model that can extract many types of information, work well at multiple hospitals, and learn from a small amount of labeled data. But how? Researchers from MIT’s Computer Science and Artificial Intelligence Laboratory (CSAIL) believed that to disentangle the data, they needed to call on something bigger: large language models. To pull that important medical information, they used a very big, GPT-3 style model to do tasks like expand overloaded jargon and acronyms and extract medication regimens. 

      For example, the system takes an input, which in this case is a clinical note, “prompts” the model with a question about the note, such as “expand this abbreviation, C-T-A.” The system returns an output such as “clear to auscultation,” as opposed to say, a CT angiography. The objective of extracting this clean data, the team says, is to eventually enable more personalized clinical recommendations. 

      Medical data is, understandably, a pretty tricky resource to navigate freely. There’s plenty of red tape around using public resources for testing the performance of large models because of data use restrictions, so the team decided to scrape together their own. Using a set of short, publicly available clinical snippets, they cobbled together a small dataset to enable evaluation of the extraction performance of large language models. 

      “It’s challenging to develop a single general-purpose clinical natural language processing system that will solve everyone’s needs and be robust to the huge variation seen across health datasets. As a result, until today, most clinical notes are not used in downstream analyses or for live decision support in electronic health records. These large language model approaches could potentially transform clinical natural language processing,” says David Sontag, MIT professor of electrical engineering and computer science, principal investigator in CSAIL and the Institute for Medical Engineering and Science, and supervising author on a paper about the work, which will be presented at the Conference on Empirical Methods in Natural Language Processing. “The research team’s advances in zero-shot clinical information extraction makes scaling possible. Even if you have hundreds of different use cases, no problem — you can build each model with a few minutes of work, versus having to label a ton of data for that particular task.”

      For example, without any labels at all, the researchers found these models could achieve 86 percent accuracy at expanding overloaded acronyms, and the team developed additional methods to boost this further to 90 percent accuracy, with still no labels required.

      Imprisoned in an EHR 

      Experts have been steadily building up large language models (LLMs) for quite some time, but they burst onto the mainstream with GPT-3’s widely covered ability to complete sentences. These LLMs are trained on a huge amount of text from the internet to finish sentences and predict the next most likely word. 

      While previous, smaller models like earlier GPT iterations or BERT have pulled off a good performance for extracting medical data, they still require substantial manual data-labeling effort. 

      For example, a note, “pt will dc vanco due to n/v” means that this patient (pt) was taking the antibiotic vancomycin (vanco) but experienced nausea and vomiting (n/v) severe enough for the care team to discontinue (dc) the medication. The team’s research avoids the status quo of training separate machine learning models for each task (extracting medication, side effects from the record, disambiguating common abbreviations, etc). In addition to expanding abbreviations, they investigated four other tasks, including if the models could parse clinical trials and extract detail-rich medication regimens.  

      “Prior work has shown that these models are sensitive to the prompt’s precise phrasing. Part of our technical contribution is a way to format the prompt so that the model gives you outputs in the correct format,” says Hunter Lang, CSAIL PhD student and author on the paper. “For these extraction problems, there are structured output spaces. The output space is not just a string. It can be a list. It can be a quote from the original input. So there’s more structure than just free text. Part of our research contribution is encouraging the model to give you an output with the correct structure. That significantly cuts down on post-processing time.”

      The approach can’t be applied to out-of-the-box health data at a hospital: that requires sending private patient information across the open internet to an LLM provider like OpenAI. The authors showed that it’s possible to work around this by distilling the model into a smaller one that could be used on-site.

      The model — sometimes just like humans — is not always beholden to the truth. Here’s what a potential problem might look like: Let’s say you’re asking the reason why someone took medication. Without proper guardrails and checks, the model might just output the most common reason for that medication, if nothing is explicitly mentioned in the note. This led to the team’s efforts to force the model to extract more quotes from data and less free text.

      Future work for the team includes extending to languages other than English, creating additional methods for quantifying uncertainty in the model, and pulling off similar results with open-sourced models. 

      “Clinical information buried in unstructured clinical notes has unique challenges compared to general domain text mostly due to large use of acronyms, and inconsistent textual patterns used across different health care facilities,” says Sadid Hasan, AI lead at Microsoft and former executive director of AI at CVS Health, who was not involved in the research. “To this end, this work sets forth an interesting paradigm of leveraging the power of general domain large language models for several important zero-/few-shot clinical NLP tasks. Specifically, the proposed guided prompt design of LLMs to generate more structured outputs could lead to further developing smaller deployable models by iteratively utilizing the model generated pseudo-labels.”

      “AI has accelerated in the last five years to the point at which these large models can predict contextualized recommendations with benefits rippling out across a variety of domains such as suggesting novel drug formulations, understanding unstructured text, code recommendations or create works of art inspired by any number of human artists or styles,” says Parminder Bhatia, who was formerly Head of Machine Learning at AWS Health AI and is currently Head of ML for low-code applications leveraging large language models at AWS AI Labs. “One of the applications of these large models [the team has] recently launched is Amazon CodeWhisperer, which is [an] ML-powered coding companion that helps developers in building applications.”

      As part of the MIT Abdul Latif Jameel Clinic for Machine Learning in Health, Agrawal, Sontag, and Lang wrote the paper alongside Yoon Kim, MIT assistant professor and CSAIL principal investigator, and Stefan Hegselmann, a visiting PhD student from the University of Muenster. First-author Agrawal’s research was supported by a Takeda Fellowship, the MIT Deshpande Center for Technological Innovation, and the MLA@CSAIL Initiatives. More

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      in Data Management & Statistics

      Study finds the risks of sharing health care data are low

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      In recent years, scientists have made great strides in their ability to develop artificial intelligence algorithms that can analyze patient data and come up with new ways to diagnose disease or predict which treatments work best for different patients.

      The success of those algorithms depends on access to patient health data, which has been stripped of personal information that could be used to identify individuals from the dataset. However, the possibility that individuals could be identified through other means has raised concerns among privacy advocates.

      In a new study, a team of researchers led by MIT Principal Research Scientist Leo Anthony Celi has quantified the potential risk of this kind of patient re-identification and found that it is currently extremely low relative to the risk of data breach. In fact, between 2016 and 2021, the period examined in the study, there were no reports of patient re-identification through publicly available health data.

      The findings suggest that the potential risk to patient privacy is greatly outweighed by the gains for patients, who benefit from better diagnosis and treatment, says Celi. He hopes that in the near future, these datasets will become more widely available and include a more diverse group of patients.

      “We agree that there is some risk to patient privacy, but there is also a risk of not sharing data,” he says. “There is harm when data is not shared, and that needs to be factored into the equation.”

      Celi, who is also an instructor at the Harvard T.H. Chan School of Public Health and an attending physician with the Division of Pulmonary, Critical Care and Sleep Medicine at the Beth Israel Deaconess Medical Center, is the senior author of the new study. Kenneth Seastedt, a thoracic surgery fellow at Beth Israel Deaconess Medical Center, is the lead author of the paper, which appears today in PLOS Digital Health.

      Risk-benefit analysis

      Large health record databases created by hospitals and other institutions contain a wealth of information on diseases such as heart disease, cancer, macular degeneration, and Covid-19, which researchers use to try to discover new ways to diagnose and treat disease.

      Celi and others at MIT’s Laboratory for Computational Physiology have created several publicly available databases, including the Medical Information Mart for Intensive Care (MIMIC), which they recently used to develop algorithms that can help doctors make better medical decisions. Many other research groups have also used the data, and others have created similar databases in countries around the world.

      Typically, when patient data is entered into this kind of database, certain types of identifying information are removed, including patients’ names, addresses, and phone numbers. This is intended to prevent patients from being re-identified and having information about their medical conditions made public.

      However, concerns about privacy have slowed the development of more publicly available databases with this kind of information, Celi says. In the new study, he and his colleagues set out to ask what the actual risk of patient re-identification is. First, they searched PubMed, a database of scientific papers, for any reports of patient re-identification from publicly available health data, but found none.

      To expand the search, the researchers then examined media reports from September 2016 to September 2021, using Media Cloud, an open-source global news database and analysis tool. In a search of more than 10,000 U.S. media publications during that time, they did not find a single instance of patient re-identification from publicly available health data.

      In contrast, they found that during the same time period, health records of nearly 100 million people were stolen through data breaches of information that was supposed to be securely stored.

      “Of course, it’s good to be concerned about patient privacy and the risk of re-identification, but that risk, although it’s not zero, is minuscule compared to the issue of cyber security,” Celi says.

      Better representation

      More widespread sharing of de-identified health data is necessary, Celi says, to help expand the representation of minority groups in the United States, who have traditionally been underrepresented in medical studies. He is also working to encourage the development of more such databases in low- and middle-income countries.

      “We cannot move forward with AI unless we address the biases that lurk in our datasets,” he says. “When we have this debate over privacy, no one hears the voice of the people who are not represented. People are deciding for them that their data need to be protected and should not be shared. But they are the ones whose health is at stake; they’re the ones who would most likely benefit from data-sharing.”

      Instead of asking for patient consent to share data, which he says may exacerbate the exclusion of many people who are now underrepresented in publicly available health data, Celi recommends enhancing the existing safeguards that are in place to protect such datasets. One new strategy that he and his colleagues have begun using is to share the data in a way that it can’t be downloaded, and all queries run on it can be monitored by the administrators of the database. This allows them to flag any user inquiry that seems like it might not be for legitimate research purposes, Celi says.

      “What we are advocating for is performing data analysis in a very secure environment so that we weed out any nefarious players trying to use the data for some other reasons apart from improving population health,” he says. “We’re not saying that we should disregard patient privacy. What we’re saying is that we have to also balance that with the value of data sharing.”

      The research was funded by the National Institutes of Health through the National Institute of Biomedical Imaging and Bioengineering. More

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      in Data Management & Statistics

      Neurodegenerative disease can progress in newly identified patterns

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      Neurodegenerative diseases — like amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), Alzheimer’s, and Parkinson’s — are complicated, chronic ailments that can present with a variety of symptoms, worsen at different rates, and have many underlying genetic and environmental causes, some of which are unknown. ALS, in particular, affects voluntary muscle movement and is always fatal, but while most people survive for only a few years after diagnosis, others live with the disease for decades. Manifestations of ALS can also vary significantly; often slower disease development correlates with onset in the limbs and affecting fine motor skills, while the more serious, bulbar ALS impacts swallowing, speaking, breathing, and mobility. Therefore, understanding the progression of diseases like ALS is critical to enrollment in clinical trials, analysis of potential interventions, and discovery of root causes.

      However, assessing disease evolution is far from straightforward. Current clinical studies typically assume that health declines on a downward linear trajectory on a symptom rating scale, and use these linear models to evaluate whether drugs are slowing disease progression. However, data indicate that ALS often follows nonlinear trajectories, with periods where symptoms are stable alternating with periods when they are rapidly changing. Since data can be sparse, and health assessments often rely on subjective rating metrics measured at uneven time intervals, comparisons across patient populations are difficult. These heterogenous data and progression, in turn, complicate analyses of invention effectiveness and potentially mask disease origin.

      Now, a new machine-learning method developed by researchers from MIT, IBM Research, and elsewhere aims to better characterize ALS disease progression patterns to inform clinical trial design.

      “There are groups of individuals that share progression patterns. For example, some seem to have really fast-progressing ALS and others that have slow-progressing ALS that varies over time,” says Divya Ramamoorthy PhD ’22, a research specialist at MIT and lead author of a new paper on the work that was published this month in Nature Computational Science. “The question we were asking is: can we use machine learning to identify if, and to what extent, those types of consistent patterns across individuals exist?”

      Their technique, indeed, identified discrete and robust clinical patterns in ALS progression, many of which are non-linear. Further, these disease progression subtypes were consistent across patient populations and disease metrics. The team additionally found that their method can be applied to Alzheimer’s and Parkinson’s diseases as well.

      Joining Ramamoorthy on the paper are MIT-IBM Watson AI Lab members Ernest Fraenkel, a professor in the MIT Department of Biological Engineering; Research Scientist Soumya Ghosh of IBM Research; and Principal Research Scientist Kenney Ng, also of IBM Research. Additional authors include Kristen Severson PhD ’18, a senior researcher at Microsoft Research and former member of the Watson Lab and of IBM Research; Karen Sachs PhD ’06 of Next Generation Analytics; a team of researchers with Answer ALS; Jonathan D. Glass and Christina N. Fournier of the Emory University School of Medicine; the Pooled Resource Open-Access ALS Clinical Trials Consortium; ALS/MND Natural History Consortium; Todd M. Herrington of Massachusetts General Hospital (MGH) and Harvard Medical School; and James D. Berry of MGH.

      Play video

      MIT Professor Ernest Fraenkel describes early stages of his research looking at root causes of amyotrophic lateral sclerosis (ALS).

      Reshaping health decline

      After consulting with clinicians, the team of machine learning researchers and neurologists let the data speak for itself. They designed an unsupervised machine-learning model that employed two methods: Gaussian process regression and Dirichlet process clustering. These inferred the health trajectories directly from patient data and automatically grouped similar trajectories together without prescribing the number of clusters or the shape of the curves, forming ALS progression “subtypes.” Their method incorporated prior clinical knowledge in the way of a bias for negative trajectories — consistent with expectations for neurodegenerative disease progressions — but did not assume any linearity. “We know that linearity is not reflective of what’s actually observed,” says Ng. “The methods and models that we use here were more flexible, in the sense that, they capture what was seen in the data,” without the need for expensive labeled data and prescription of parameters.

      Primarily, they applied the model to five longitudinal datasets from ALS clinical trials and observational studies. These used the gold standard to measure symptom development: the ALS functional rating scale revised (ALSFRS-R), which captures a global picture of patient neurological impairment but can be a bit of a “messy metric.” Additionally, performance on survivability probabilities, forced vital capacity (a measurement of respiratory function), and subscores of ALSFRS-R, which looks at individual bodily functions, were incorporated.

      New regimes of progression and utility

      When their population-level model was trained and tested on these metrics, four dominant patterns of disease popped out of the many trajectories — sigmoidal fast progression, stable slow progression, unstable slow progression, and unstable moderate progression — many with strong nonlinear characteristics. Notably, it captured trajectories where patients experienced a sudden loss of ability, called a functional cliff, which would significantly impact treatments, enrollment in clinical trials, and quality of life.

      The researchers compared their method against other commonly used linear and nonlinear approaches in the field to separate the contribution of clustering and linearity to the model’s accuracy. The new work outperformed them, even patient-specific models, and found that subtype patterns were consistent across measures. Impressively, when data were withheld, the model was able to interpolate missing values, and, critically, could forecast future health measures. The model could also be trained on one ALSFRS-R dataset and predict cluster membership in others, making it robust, generalizable, and accurate with scarce data. So long as 6-12 months of data were available, health trajectories could be inferred with higher confidence than conventional methods.

      The researchers’ approach also provided insights into Alzheimer’s and Parkinson’s diseases, both of which can have a range of symptom presentations and progression. For Alzheimer’s, the new technique could identify distinct disease patterns, in particular variations in the rates of conversion of mild to severe disease. The Parkinson’s analysis demonstrated a relationship between progression trajectories for off-medication scores and disease phenotypes, such as the tremor-dominant or postural instability/gait difficulty forms of Parkinson’s disease.

      The work makes significant strides to find the signal amongst the noise in the time-series of complex neurodegenerative disease. “The patterns that we see are reproducible across studies, which I don’t believe had been shown before, and that may have implications for how we subtype the [ALS] disease,” says Fraenkel. As the FDA has been considering the impact of non-linearity in clinical trial designs, the team notes that their work is particularly pertinent.

      As new ways to understand disease mechanisms come online, this model provides another tool to pick apart illnesses like ALS, Alzheimer’s, and Parkinson’s from a systems biology perspective.

      “We have a lot of molecular data from the same patients, and so our long-term goal is to see whether there are subtypes of the disease,” says Fraenkel, whose lab looks at cellular changes to understand the etiology of diseases and possible targets for cures. “One approach is to start with the symptoms … and see if people with different patterns of disease progression are also different at the molecular level. That might lead you to a therapy. Then there’s the bottom-up approach, where you start with the molecules” and try to reconstruct biological pathways that might be affected. “We’re going [to be tackling this] from both ends … and finding if something meets in the middle.”

      This research was supported, in part, by the MIT-IBM Watson AI Lab, the Muscular Dystrophy Association, Department of Veterans Affairs of Research and Development, the Department of Defense, NSF Gradate Research Fellowship Program, Siebel Scholars Fellowship, Answer ALS, the United States Army Medical Research Acquisition Activity, National Institutes of Health, and the NIH/NINDS. More